Question

what do you think are the most influential events in the US history of community and public health? What were the outcomes? Why did you choose these as more influential than others?

Answer 1

“Inequalities in health status in the U.S. are large, persistent, and increasing. Research documents that poverty, income and wealth inequality, poor quality of life, racism, sex discrimination, and low socioeconomic conditions are the major risk factors for ill health and health inequalities… conditions such as polluted environments, inadequate housing, absence of mass transportation, lack of educational and employment opportunities, and unsafe working conditions are implicated in producing inequitable health outcomes. These systematic, avoidable disadvantages are interconnected, cumulative, intergenerational, and associated with lower capacity for full participation in society….Great social costs arise from these inequities, including threats to economic development, democracy, and the social health of the nation.(1)

Some Major Achievements of Public Health During the 20^th Century

• Vaccination to reduce epidemic diseases
• Eradication of smallpox
• Improved motor vehicle safety
• Safer workplaces
• Control of infectious diseases
• Decline in death from cardiovascular disease
• Improvements in maternal and child health
• Family planning
• Fluoridation of drinking water
• Reductions in prevalence of tobacco use(2)

From from the US National Library of Medicine's web pages on The History of the Public Health Service:

"Medical discoveries and public health campaigns have almost eliminated deaths from the common diseases of childhood such as measles, diphtheria, scarlet fever, and whooping cough. As a result of these successes nearly 20 years were added to the average life expectancy at birth between 1900 and 1950-from 47 to 67 years."

"As epidemic diseases were brought under control the Public Health Service began to shift its attention to other areas such as cancer, heart disease, health in the workplace, and the impact of environmental problems, such as toxic waste disposal, on health. But the Public Health Service is still called upon to investigate outbreaks of disease such as Legionnaire's, toxic shock syndrome, and now the deadliest epidemic of our age -- AIDS. Much of the work of the early plague fighters and sanitarians is now carried out by the scientists at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia."

• 1952 Polio cases surge in the US. Early testing of the vaccine developed by Jonas Salk is encouraging.
• 1953 Under President Eisenhower, Congress created the Department of Health, Education, and Welfare (HEW).
• 1954 A large scale clinical trial of the Salk vaccine begins
• 1959 Rene Dubos published a landmark book entitled "The Mirage of Health" in which he convincingly argued that the decline in mortality since 1850 was not primarily due to laboratory medicine; it was due to control of infectious disease as a result of sanitation and improvements in nutrition. He also pointed out that Western health was not optimal and that life expectation at age 45 had improved little. Moreover, one out of four Americans spent at least some time in mental hospitals. Increasing levels of drug dependency (all kinds of drugs) also indicated that health was not optimal. Dubos took the position that medicine's concept of specific etiologies (and therefore magic bullets that could cure disease) was misleading. He said that disease is complex and tends to be rooted in social, physical, and cultural environment in which people lived.
• 1970 The Occupational Safety and Health Act was passed by Congress, and the Occupational Safety and Health Administration was founded in 1971.
• 1970 The Environmental Protection Agency (EPA) was established to consolidate federal research, monitoring, standard-setting and enforcement activities to ensure environmental protection.
• 1979 HEW's educational tasks were transferred to the new Department of Education and responsibility for health was given to the newly organized Department of Health and Human Services (HHS).
• 1979 Smallpox is declared eradicated by the World Health Organization. The eradication of smallpox, one of the deadliest and most dreaded diseases, was the result of a massive global effort utilizing case finding and vaccination. The last known case occurred in 1977 in Somalia.
• 1980 President Jimmy Carter signed into law the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA or Superfund). This historic new statute gave EPA the authority to clean up uncontrolled hazardous waste sites and spills.
• 1981 Dr. Michael Gottlieb and his associates report on four previously healthy young men who had developed Pneumocystis carinii pneumonia. They hypothesized that this was a new syndrome of acquired immunodeficiency cause by a sexually transmitted infectious agent.
• 2002 The Institute of Medicine issued a report entitled "Who Will Keep the Public Healthy?" The report concluded that "... public health professionals must have a framework for action and an understanding of the forces that impact on health, a model of health that emphasizes the linkages and relationships among multiple determinants affecting health. Such an ecological model, the committee believes, is key to effectively addressing the challenges of the 21st century."(2)

These events resulted in discovering cures and vaccinations to some of deadly diseases .These were more influential because from 20 th century public health was viewed as an important milestone aiding in development of a country.

ref:

1.National Association of County and City Health Officials Health and Social Justice Committee. Creating Health Equity Through Social Justice. National Association of County and City Health Officials. Available at http://archive. naccho.org/documents/healthsocialjusticepaper5.pdf.

2.A Brief History of Public Health,Centers for Disease Control and Prevention History,Core Functions of Public Health,Public Health Museum in Massachusetts. retrieved from MPH-Modules/PH/PublicHealthHistory/PublicHealthHistory_print.html.

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